Oppositional Defiant Disorder What is it?

1. Oppositional Defiant DisorderWhat is it? Larry Burd Department of Pediatrics University of North Dakota 701-777-3683

2. Onset in Childhood • Temperament • Developmental Disorders • More boys

3. Accompanying Disorders • ADHD >80% • Speech and Language Disorders • Social Skill Defecits • Sleep Disorders • Gross Motor Delay

4. Low Frustration Irritable

5. Sleep Disorders Late to bed Up at night Snoring Parents’ bed

6. Ending Activities Changing

7. Gross and Fine Motor Dressing Tying shoes Zipping Writing < Bilateral coordination

8. Peer Relationships Social skills Exploitation Empathy Attachment

9. Parents • Many single parents • Limited resources • Family History (20-30%)

10. ODDWhat to Do

11. Oppositional Defiant Disorders  ___ Speech delays ___ Language delays ___ Difficulty understanding ___ Irritable ___ Impatient ___ Sleep problems ___ Hard to get to bed ___ Wakes up often ___ Gets out of bed in the night ___ Sleeps with parent(s) ___ Hits ___ Kicks ___ Bites ___ Throws ___ Temper tantrums ___ Won’t listen ___ Hyperactive ___ Poor attention ___ Social skill deficits ___ Poor coordination ___ Clumsy   Most frequent _______________________ _______________________  Most difficult _______________________

12. Management • Parent training • Time out • Positive behavior management • Speech and language therapy • ADHD treatment

13. Parent Training • Education • Planned Ignoring • M & M’s • The Store • Bedtime • Getting dressed • Respite care • Sleep in own bed

14. Management – Time Out • Time away • 1 - 2 minutes each year • 1 – 2 behaviors • Attend to positive behavior

15. Positive Behavior • Does child have the behavior on demand? • Catch ‘em being good • Stars • M&M’s

16. Speech Language Therapy Expressive Receptive Comprehension

17. ADHD • Assessment • Education • Behavioral Intervention • Medication

18. Sleep • Bedtime ritual • set time 8:00 – 8:30 • 4-5 activities • no scaring • reward success – last night’s success

19. Getting Dressed • Allow plenty of time • Pick the clothes • Reward success

20. The Store • Go when you don’t need anything • Talk before going in • Have reward ready • No second chance that day

21. Social Skills • Observe • Identify • Teach • Positive skills • Identify skilled partner

22. Directions • Short - short • Low key approach

23. Irritable • Ignore temper tantrums • Catch ’em being good

24. Easy Living • Plan ahead • Slow pace • Reward change

25. Better Listening • Come here • Eat this M & M • Treasure hunt

26. Everybody Gets to Sleep • Bed time ritual • No more talking • No hugs of kisses • No drinks • Sleeps in own bed (no exceptions)

27. Attending and Behavior Change • Catch ’em being good

32. Picture or Reward Picture or Reward Target Behavior _____________________________________________ Morning ___ ___ ___ ___ ___ Afternoon ___ ___ ___ ___ ___ Target Behavior _____________________________________________ Morning ___ ___ ___ ___ ___ Afternoon ___ ___ ___ ___ ___ Evening ___ ___ ___ ___ ___

34. Teaching and Learning • Task: _______________________________ • Reinforcer:___________________________

35. Task:_________________________________ • Reinforcer: + - Improved + No change Worse - - -

36. Teaching and Learning + - • Task:_______________________________ • Reinforcer: - Doesn’t understand - Can’t do it + Improved Unchanged - Doesn’t work Worse - - - 1 2 3